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Flashcards in TUMORS Deck (81):
1

____________stains ependymomas and choroid plexus
tumors, Decreased staining in higher grade tumors

GFAP

2

___________proliferation indices roughly
correlate with tumor grade and mitosis count

Ki-67 (MIB-1)

3

Molecular genetics of astrocytoma

__________in 40–50% of diffuse astrocytomas
(chromosome 17)—these appear to
progress more frequently
Increased ___________



TP53 mutations


platelet-derived growth factor
receptor (PDGFR)- mRNA expression

4

Cells with plump, eosinophilic cell bodies and
short processes
Nuclei are usually eccentric with small nucleoli
Perivascular lymphocytes common

Gemistocytic astrocytoma (WHO grade II)

5

Lots of gemistocytes associated with _________ behavior (20% or more gemistocytic
component)

more
aggressive

6

__________intensely eosinophilic, elongate,
or corkscrew-shaped structures

Rosenthal fibers—

7

P16 deletion (30%), RB alterations (25%), P19
deletion (15%), CDK4 amplification (10%)

Hypercellularity with more prominent nuclear
pleomorphism vs low-grade astrocytoma
– Mitotic figures more readily identifiable

Anaplastic astrocytoma (WHO grade III)

8

Several possible origins
– Astrocytic dedifferentiation
– Nonastrocytic glioma differentiation

GBM

9

Several possible origins of GBM
1. _________
2. ________

– Astrocytic dedifferentiation
– Nonastrocytic glioma differentiation

10

Most common glioma, 50–60% of all astrocytic
neoplasms, 12–15% of all intracranial neoplasms

GBM

11

Pathology of GBM

1. Perinecrotic __________ by tumor cells
(may be variably present)
2. Usually areas of prominent cellularity and
nuclear pleomorphism


pseudopalisading

12

GBM are focally __ positive,________positive,
_______ positive

GFAP, S-100 , vimentin

13

Considered by many to be a GBM variant, genetic
changes similar to GBM
<2% of GBMs
Similar presenting features, age distribution, and
prognosis as GBM
Temporal lobe most common site
Sarcoma and GBM microscopically
Increased metastases—sarcoma part

Gliosarcoma/ Feigin’s tumor

14

– Generally looks like an infiltrating astrocytoma
– Peripheral margin cells are elongated and
slender
– Mitotic activity variable
– GFAP positive
– Secondary structures of Sherer common

Gliomatosis cerebri

15

Discrete cystic mass; radiographically a cystic
tumor with enhancing mural nodule(s)
Most common glioma in children, associated with
neurofibromatosis type I

Pilocytic astrocytoma (WHO grade I)

16

Associated with tuberous sclerosis (<20 years), can
occur later in life

Often associated with smaller hamartomas, which have been likened to “candle drippings

Giant cells with glassy eosinophilic cytoplasm
– Smaller elongated cells in background

SGCA

17

-First two decades, most commonly
-Seizures first decade of life
Cystic with mural nodule(s) configuration

Pleomorphic xanthoastrocytoma

18

Most arise in childhood, rarely adults
– Fasciculated and elongated cells
– May see anaplastic astrocytoma or GBM
– Most fibrillary, diffuse astrocytoma

BGG

19

First decade
Neurofibromatosis type I associated—bilateral
Adults—anterior optic pathway, aggressive

Optic Nerve Glioma

20

10–25% of glial neoplasms
Long history of signs and symptoms (mean 1–5
years) prior to diagnosis
Seizures, headaches most common symptoms;
about 20% hemorrhage

LG oliGo

21

-Sheets of cells, scant cytoplasm, rounded
central nucleus, vesicular chromatin
– Vacuolated “fried egg” appearance—formalin
fixation artifact
– Minimal nuclear pleomorphism
– Arcuate or “chicken wire” vascular pattern

ODG

22

Most frequent genetic alteration in ODG present is___

LOH
chromosome 19q

23

Type of ODG

Worse prognosis than low-grade tumor, median survival 3–4 years
1p and 19q chromosome deletions associated with increased likelihood of chemoresponsiveness

Anaplastic oligodendroglioma

24

– Flexner-Wintersteiner
• Small lumen
• Cuboidal lining

• Retinoblastoma

25

_______ (tumor cells arrange themselves
around something)

Pseudorosettes

26

– Homer Wright
• Fibrillary core
• Neuroblastic differentiation

PNET

27

Any ventricle (especially 4th) and spinal cord
(intramedullary); most common tumor of the
spinal cord

Low-grade ependymoma

28

– “Islands of blue (nuclei) in a sea of pink (fibrillary
background)”
– Nuclei-like ependymoma
– Mitoses rare, low cell proliferation marker
indices
– Calcification common
– GFAP and S-100 protein positive
– No rosettes or pseudorosettes
– Microcystic change common
– Excellent prognosis, surgical removal usually
curative
– More likely

subependyomoma

29

Slow growing
May be locally infiltrative, hemorrhagic, or
lobular
25% encapsulated
Filum terminale
Rarely subcutaneous sacrococcygeal region or
elsewhere in spinal cord

Myxopapillary ependymoma

30



May express progesterone > estrogen receptors

Most arise proximal to meninges from arachnoidal
cap cells;

______ is single most
common site of origin

MENINGIOMA



falx cerebri

31


__________—cells arranged in
lobules divided by collagenous septae, whorling of cells around vessels or psammoma bodies (calcifications), eosinophilic cytoplasmic
protrusions into the nuclei prominent
(nuclear pseudoinclusions)

______—spindle cells with
abundant collagen or reticulin between cells

– Transitional (mixed)—features of both
meningothelial and fibrous types

– Psammomatous—abundant _____

– Angiomatous—marked by prominent vasculature, not to be confused with hemangiopericytoma
or hemangioblastoma
– Microcystic—loose, mucinous background
– Secretory (pseudopsammomatous)—
formation of intracellular lumina containing
PAS positive, eosinophilic material
– ________ rich—marked by extensive chronic inflammation
– Metaplastic—demonstrates mesenchymal
differentiation

– Meningothelial (syncytial)








– Fibrous (fibroblastic)





calcifications









Lymphoplasmacyte

32

IHC of Meningioma


Most common cytogenetic abnormality is deletion of chromosome_____

Immunohistochemistry: most EMA and vimentin positive

22q

33

Four histological subtypes have been associated
with more aggressive behavior
______—areas similar to chordoma with
trabeculae of eosinophilic and vacuolated cells
in a myxoid background, WHO grade II tumor
_________—cells with clear, glycogen-rich
cytoplasm, WHO grade II tumor

_________perivascular pseudopapillary
pattern, WHO grade III tumor
_________rhabdoid-like cells with eccentric
nuclei, prominent nucleoli, and cytoplasmic
inclusions of intermediate filaments, WHO
grade III

– Chordoid






– Clear cell


--Papillary—

– Rhabdoid—

34

Relatively rare sarcoma of CNS
May cause lytic destruction of adjacent bone, no hyperostosis
Grossly a solid, well-demarcated mass, tends to bleed during removal

Hemangiopericytoma

35

Derived from notochordal tissue remnants
(ecchordosis physaliphora)
Most arise in spheno-occipital region or clivus
and sacrococcygeal region
Bone-based tumors, lobulated, may appear
grossly mucoid

Chordoma

36

Positive for S-100 protein, HMB45, melan A;
negative for cytokeratin and GFAP stains

Poor prognosis

Melanoma

37

Cerebellum most common site, less commonly brain stem and spinal cord

Cyst with enhancing mural nodule appearance
radiographically

Hemangioblastoma

38

Associated with SV40 DNA sequences
Associated with Li-Fraumeni syndrome
Potentially curable by surgery with 5-year
survival rate of up to 100%

Choroid plexus tumors

39

Homer Wright pseudorosettes < 40% of cases

Typical histopathology marked by densely packed
cells with high nuclear-to-cytoplasmic ratio

Medulloblas

40

Histologically marked by rhabdoid cells
with eosinophilic cytoplasm, eccentric nucleus, prominent nucleolus


Cytoplasmic “pink body”—corresponds to
collections of intermediate filaments

express EMA and vimentin

Atypical teratoid/rhabdoid tumor

41

Also known as neurilemmoma, neurinoma,
acoustic neuroma
Arises from peripheral nerve
8% of intracranial and 29% of primary spinal
cord tumors
Associated with neurofibromatosis type II

Schwannoma

42

Cell types of Schwannoma

Composed microscopically of spindled cells
with alternating areas of compact cells (Antoni
A pattern) and less cellular looser regions
(Antoni B pattern)

43

associated with
neurofibromatosis type II

Plexiform schwannoma—

44

stains for schwannoma

strong and diffuse
staining with S-100 protein, GFAP negative

45

Associated with neurofibromatosis type I
May present grossly as a cutaneous nodule or asa diffuse lesion;

plexiform tumors are multinodular
“bag of worms. Histologically composed of an admixture of Schwann cells, perineurial-like cells, and fibroblasts
in a mucoid/loose matrix

Neurofibroma

46

MC supratentorial site of lymphoma

MC type

Virus associated in IC

Frontal

DLBCL

EBV

47

Grossly appear as yellow or white dural
nodules or granular parenchymal infiltrate
– Osteolytic bone changes
- Birbeck granules--tennis-racket-shaped
intracytoplasmic pentalaminar structures

Langerhans cell histiocytosis

48

MC location of colloid cyst

Third ventricle—near foramen of Monro

49

Subarachnoid space in the temporal lobe region
is favored site
Delicate, translucent wall filled with clear fluid
EMA positive by immunohistochemistry

Arachnoid cyst

50

MC site of epidermoid cyst

Epidermoid: cerebellopontine angle is most
common site, may occur in other sites, i.e.,
suprasellar

51

Locations of dermoid

Dermoid: posterior fossa, midline lesions, 4th
ventricle

52

0.3–0.5% of primary intracranial tumors in adults, 3% in children
Occur along the midline,most commonly
suprasellar region and pineal

Germinoma

53

Immunoreactivity:

________placental alkaline phosphatase, ________fetoprotein,
__________CD30,
___________—HCG and HPL


germinoma—

yolk sac--
embryonal carcinoma—
choriocarcinoma

54

May originate from squamous cells at the base of the infundibular stalk

Cut section: necrotic debris, calcium, “cystic
oil” often with cholesterol
– Spillage of the “oil” may result in chemical
meningitis

Craniopharyngioma

55

Most common secreting adenoma—_____

prolactinoma

56

Microadenoma size

<1cm

57

May be associated with developmental abnormalities,
i.e., agenesis of the corpus callosum

Usually midline: corpus callosum, 3rd ventricular
region, CP angle, quadrigeminal area

lipoma

58

MC site of EDH

Most are frontal or temporal and associated with a laceration of one of the meningeal arteries,
most commonly the middle meningeal artery;
secondary to a fracture

59

Resulting from tearing of bridging veins, which transverse through the subarachnoid space

SDH

60

Microscopic dating of subdural hematoma
– A few days—intact red blood cells

_______lysis of clot with macrophages,
hemosiderin
– 2 weeks—growth of fibroblasts from the dural surface into the hematoma with small blood
vessel proliferation
______early development of hyalinized
connective tissue



– 1 week—





1-3 months

61

soft tissue swelling and discoloration
in the area of the mastoid, secondary to
blood in the mastoid air cells

Battle sign—

62

_____represents periorbital ecchymoses,
may be seen with basilar skull fractures

Raccoon eyes—

63

a bruise of the brain resulting in
infarct

Typically wedge-shaped and preferentially
affect the crown of the gyri

contusion

64

contusions at a distance from and frequently roughly opposite to the point of trauma

Contrecoup lesions

65

the object enters but
does not completely transverse the brain (stab
wounds, low velocity gunshot)

Penetrating brain wounds—

66

________wounds in which the
object passes through the brain and exits

Perforating brain wounds—

67

May get avulsion of the pontomedullary or cervicomedullary
junction with s_______

severe hyperextension
of neck

68

-total failure of closure
– Brain and cord exposed to amniotic fluid

Craniorachischisis totalis—

69

subcutaneous herniation of
meninges through defective closure of vertebral arch

Meningocele

70

– Congenital dilatation of central canal
– Associated with meningomyelocele and Chiari
malformation
– Rarely symptomatic

Hydromyelia

71

– Slit or tubular cavitation of cord (syrinx = tube)
– Most commonly cervical or thoracic cord
– Cavity may be multiple, irregular
– May be filled with fluid associated with
compression and damage to surrounding tissue

Syringomyelia

72

failure of
anterior telencephalon to divide or normal forebrain
development, i.e., incomplete separation
of the cerebral hemispheres across the midline

Holoprosen

73


• Downward herniation of cerebellar tonsils
• No elongation of medulla and 4th ventricle
• No associated spina bifida
• Often asymptomatic, may cause late-onset
hydrocephalus

Arnold chiari type 1

74

Cerebellar malformations, displacement of
vermis below the foramen magnum

Arnold chiari type 2

75

Hypoplasia or aplasia of cerebellar vermis
Cystic dilatation of 4th ventricle
• Enlargement of posterior fossa
• Hydrocephalus symptoms early, prominent
occiput

Dandy-Walker syndrome

76

Most develop by the 16th week of gestation
All marked by an abnormal arrangement of
neurons in the cortex

(cortical
dysplasia)

77

associations of cortical dysplasia

Association with tuberous sclerosis, neurofibromatosis
type I, and epidermal nevus syndrome

78

Normal development
–________—first fissures form
_________—secondary sulci form
_________—tertiary sulci
form

5th month
– 3rd trimester
– 3rd trimester to 6 months of age

79

• Pachygyria and polymicrogyria; poor cortical
layering
• Peroxisome abnormality

Zellweger syndrome

80

Asymptomatic or associated with mental retardation,
seizures, and speech disturbances
– Associated with holoprosencephaly, pachygyria,
schizencephaly, fetal alcohol syndrome,
and X-linked dominant Aicardi’s syndrome

Agenesis of corpus callosum

81

• Normal in newborn, separation of the leaflets
of the septum pellucidum
• Asymptomatic

Cavum septi pellucidi